Question

Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical unit after undergoing removal of a section of the colon for colorectal cancer. The patient does not have a colostomy. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact. There is a Jackson-Pratt drain intact with minimal serous sanguineous drainage present. The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of brown liquid. The patient has no bowel sounds. The Foley catheter has a small amount of dark amber-colored urine without sediments. The patient has sequential compression device (SCD) in place. The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O2 at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate 110 bpm; respiratory rate 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time. (Learning Objectives 4 and 7)

Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed.

What gerontological postoperative considerations should the nurse make?

Answer 1

Ans) colectomy: colectomy is bowel resection of the large intestine.it means surgical removal or part of the colon.the sesegment of the colon to be removed is then freedom from the attachment to other organs and abdominal wall.

Postoperative problems:

Infection.

Hemorrhage.

Deep vein thrombosis.

Pulmonary embolism.

Injury to organs near the colon ,such as bladder and small intestines.

Nursing diagnosis:

Ineffective breathing pattern is related to pulmonary embolism as evidenced by ABG analysis.

Hemorrhage is related to surgical procedure.

Altered level of consciousness is related to anaesthesia during postoperatively.

Altered skin integrity is related to surgical procedure as evidenced by observation.

Altered tissue perfusion is related to dehydration.

Pain is related to surgical procedure.

Interventions:

provide routine care for the surgical patients.

Monitor the bowel sounds and degree of abdominal distension.

Assess the position and patency of the nasogastric tube,connecting to the low suction.if tube becomes clogged,gently irrigate with sterile normal saline.

Assess color amount and odor of drainage.

Maintain I/O chart for electrolyte imbalance.

Provide regular dressing to prevent infection or hemorrhage.

Maintain IV fluids while nasogastric suction is in place.

Provide psychological support to the patient and family members.

gerontological postoperative considerations:

In general postoperative mortality rate in geriatric surgical patients(over 70 years) is low.

Elderly patients who undergoing laparoscopic surgery have fewer complications compared to open surgery.

The nurse should make considerations are:

Decrease psychological reserve

Increased confusion

Hypoxia,hypotension

Sleep disturbance(sun downing).

Monitor carefully , frequently

Mental status - attributed to medications,pain ,anxi,depression.

Fluid and electrolyte imbalance

Skin

Altered sensory

Mobility restrictions.